Provider Demographics
NPI:1881141596
Name:CANAVAN, DANELLE CRINION
Entity type:Individual
Prefix:MS
First Name:DANELLE
Middle Name:CRINION
Last Name:CANAVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S DILLARD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3991
Mailing Address - Country:US
Mailing Address - Phone:407-877-0029
Mailing Address - Fax:
Practice Address - Street 1:9508 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3416
Practice Address - Country:US
Practice Address - Phone:954-689-0730
Practice Address - Fax:888-725-9013
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist